Abstract
BackgroundIncreasing evidence has suggested that the presence of remnant lipoproteins is a significant risk factor for atherosclerosis. Remnant lipoproteins are lipoproteins that are rich in triglycerides (TGs), and the main components include very-low-density lipoprotein (VLDL) in the fasting state. Diabetic patients often have hypertriglyceridemia with elevated levels of VLDL cholesterol but normal levels of low-density lipoprotein cholesterol (LDL-C). The aim of the present study was to elucidate the potential role of remnant lipoproteins-induced atherosclerosis in the occurrence and development of in-stent restenosis (ISR) in diabetic patients with coronary artery disease.MethodsThe present study enrolled 2312 patients with type 2 diabetes mellitus who underwent percutaneous coronary intervention from January 2013 to December 2014 and who were followed up by angiography. Patients were divided into two groups based on the presence or absence of ISR, and multivariate Cox’s proportional hazards regression modelling showed that remnant-like particle cholesterol (RLP-C) was an independent risk factor for ISR. According to the receiver operating characteristic curve, the optimal cutoff point of the RLP-C was identified, and the patients were further divided into 2 groups. Propensity score matching analysis was performed, and 762 pairs were successfully matched. Log-rank tests were used to compare Kaplan–Meier curves for overall follow-up to assess ISR.ResultsThe multivariate Cox’s proportional hazards regression analysis showed that RLP-C was independently associated with ISR, and the baseline RLP-C level at 0.505 mmol/L was identified as the optimal cutoff point to predict ISR. Patients were divided into 2 groups by RLP levels. After propensity score matching analysis, a total of 762 pairs matched patients were generated. Kaplan–Meier curves showed that the estimated cumulative rate of ISR was significantly higher in patients with RLP-C levels ≥ 0.505 mmol/L (log-rank P < 0.001; HR equal to 4.175, 95% CI = 3.045–5.723, P < 0.001) compared to patients with RLP-C levels < 0.505 mmol/L.ConclusionsThe present study emphasized the importance of remnant-like particle cholesterol in cardiovascular pathology in diabetic patients. Physicians should take measures to control RLP-C below the level of 0.505 mmol/L to better prevent of in-stent restenosis in diabetic patients.
Highlights
Increasing evidence has suggested that the presence of remnant lipoproteins is a significant risk factor for atherosclerosis
receiver operating characteristic (ROC) curve analysis indicated that the AUC was 0.722, which showed a good predictive accuracy of remnant-like particle cholesterol (RLP-C) for the risk of in-stent restenosis (ISR) in diabetic patients after baseline percutaneous coronary intervention (PCI) (Fig. 1)
Physicians should take measures to lower the level of remnant-like particle cholesterol to < 0.505 mmol/L to better prevent in-stent restenosis in diabetic patients
Summary
Increasing evidence has suggested that the presence of remnant lipoproteins is a significant risk factor for atherosclerosis. The aim of the present study was to elucidate the potential role of remnant lipoproteins-induced atherosclerosis in the occurrence and development of in-stent restenosis (ISR) in diabetic patients with coronary artery disease. A recent multicentre study has shown that the prevalence of dyslipidaemia has reached up to 67.1% among diabetic patients in China [6] and is uniquely manifested by high levels of triglycerides (TGs) and very-low-density lipoprotein cholesterol (VLDL-C) but normal levels of low-density lipoprotein cholesterol (LDL-C) [7]. Recent studies have shown that high levels of remnant lipoproteins can predict coronary events in diabetic patients independent of the degree of coronary stenosis, age, gender, hypercholesterolaemia, low-density lipoprotein, hypertriglyceridaemia and other risk factors [9]. It is of great significance to elucidate the role of RLP-induced atherosclerosis in diabetic patients
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